VA debuts new model for claims process

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The Department of Veterans Affairs (VA) announced July 11 it is deploying a new model for processing compensation benefits claims at 16 of its regional offices. The new model is part of a comprehensive transformation plan designed to yield an estimated 150,000 to 200,000 additional compensation claim decisions annually, while ensuring that veterans who are most in need get high priority.

"This new model is a part of our comprehensive plan to eliminate the compensation claims backlog," said Allison Hickey, VA’s undersecretary for benefits. "Our redesigned model follows comprehensive planning and testing to ensure we have the right recipe for success."

As of July 11, VA reported a total number of 883,914 pending disability claims in its system; 588,447 of those are in backlog (pending more than 125 days).

For the past two fiscal years, VA has completed more than 1 million claims; Hickey said the department is on target to hit the same benchmark for fiscal 2012. In the past four months, the accuracy rate for VA claims processors has risen from 83 to 87 percent.

Recently, VA has been focusing on completing the disability claims for Vietnam War-era veterans. Last year, 260,000 claims for Agent Orange-related illnesses were completed.

"We are done with that, and redirecting more than 2,300 claims experts to handle the remaining backlog," Hickey said, adding that 83 percent of veterans from the global war on terrorism who filed disability claims are already receiving benefits.

The new organizational model involves the special handling of claims from veterans with the most serious injuries or illnesses, experiencing financial hardships, or are homelessness, and need immediate attention. Through a new "intake processing center," claims are routed to one of three segmented lanes:

• Express: claims that have only one or two medical conditions, or have all the supporting documentation, medical evidence and service records needed for an expeditious rating decision (referred to as fully developed claims).

• Special Operations: claims requiring special handling because of the unique circumstances of the veterans. These include financial hardship, homelessness, serious wounds, injuries or illnesses, post-traumatic stress disorder associated with military sexual trauma, and former prisoner-of-war status.

• Core: claims with more than two medical conditions, or those that will need additional evidence to make a compensation decision.

The segmented-lanes approach helps to increase speed and accuracy because the claims specialists are processing claims with similar levels of complexity. Hickey said that VA expects 20 percent of claims to be handled in the express lane, 20 percent in special operations, and 60 percent in the core lane.

Veterans and their veterans service organization representatives are encouraged to provide all the needed evidence along with their application in a "fully developed claim" in order to expedite the process. Hickey said that any veteran who wants to file a claim should work with their VSOs, who know how to thoroughly develop claims and, secondly, be sure to use VA’s disability benefits questionnaires.

All of the people, processes, and technology initiatives in VA’s transformation plan should be fully implemented at all 56 VA regional offices by the end of 2013. To learn more about how to file fully developed claims, using VA’s new DBQs, click here.

More in Veterans Benefits Center

Larry Dalton Gifford

I am a 110/80% disabled Vietnam Marine Veterans, served in Nam from 9-20-1966 to 10-22-1967. During that time I have received many disabilities from the VA. I required disability for PTSD In January of 2013 and just received a letter back saying that I wasn't approved. They stated that I may be asked to participate in an informal conference with the Decision Review Officer to discuss your case. So at this point I don't know what to do. I have had the American Legion to represent me in the past, so I think I need you help. I sent off my original request in January 2013 and was denied, so I sent another claim with all the information marked in yellow that says that I have a claim and then it was denied again on 11-27-2013 (received the letter on 1-10-2014. So I need to now see someone from the American Legion help me with this claim and let me know how to processed.
Your truly
Larry Dalton Gifford, Corporal USMC.
18 S Kingsbridge Place Apt. A
Chesapeake, Va. 23322
Phone: 757-410-5998

jimmyrochforth

Zoobie

pdadams

Well I applied for SC and unemployability on Nov 7, 1994. I am up to 60% and still fighting for 100% UI. I have PTSD due to MST(military sexual trauma). I would suggest everyone get an e-benefits account. You can follow you claim or appeals process on it.

John Stanfield

LISTEN UP AND TAKE ACTION!!
I was in the same boat, going in circles for almost four years. Then I visited the American Disable Veteran's representative at the VA Hospital in Gainesville, FL. Only one hitch - you need to have a documented disability for them to legally help you. He was more than willing to help, actually took over and had me to him any notifications I received. He worded the responses and sent them in. These folks know the system and how to work it. RESULTS: in 9 MONTHS I went from 30% to 85% disability. After 2 more months I went to 100% and Unemployable. Extra value - 100% takes my yearly property tax down to zero.

Walbum

My case has been going on for over a year.
So long that they my evidence already sent is outdated so they want me to resend.I have resent everything that was requested of me.Now they want evidence to show if my problems are worse.They have access to my medical records so that should be all that is needed. Today I able to put in a request to mental health to send another report of my state of being.Maybe that will be all that they need.

estoesser

The just say no administration ( V A )is doing it's best to insure that 80% of the claims are denied. If I had worked at the pace these guys work, would have been fired from every job I had.
If anyone was in a special operations unit, just deny us. That's what you are doing any way. Maybe we should have veterans runing this in stead of a bunch of college grads that were able to get out of serving so they could tell us what is right for us vet's

Ray Rector

In 2011 I filed an appeal of my benefit denial. In May 2012 I received a claim decision letter from the BVA stating that a decision was reached. The "Welcome" letter came in a packet with a Benefits Eligibility Handbook. The Handbook is personalized with my name and gives the specific Group and Priority Level Benefit information that pertains to my individual eligibility. I am waiting for a Declarations Letter to confirm when my Compensation will begin. The packet/letter arrived 2 months ago and the ebenefits VA website still says "appeal pending". We seem to have many people doing each person's job and they don't communicate what each other need to know to complete the job. One group (BVA) completed their review and the other groups don't know that anything happened. When/How do I get the VA to take the next step and begin my benefits?

sbrooks

Ray Rector

Thank you for your response. It would certainly be a positive change if your answer did not feel quite so similar to the empty, mechanical responses and promises that we get from the V.A.
"Forwarded to your VA&R Division" means exactly what?
Does my request fall off of another desk, or does something actually get accomplished? Since the VA sent the decision letter, and personalized Benefit Package and then hibernated 3 months ago, it will be a welcome change to see that someone cares enough to follow thru and get some results. Thank you so very much.